Harsh Reproductive Math in the Slums

RECIFE, Brazil — “You just press the ring here, and put it inside your vagina, and keep pushing it until it’s comfortable … It’s very comfortable, you’re gonna have fun.”

The volunteer health worker demonstrates how she would explain the mechanics of the female condom to women like Elieta Da Silva, who lives in Coelhos, a poor community in the center of Recife. She passes the beige, parabolic contraption to Elieta, who pinches its plastic ring with two fingers and smirks with satisfaction.

Elieta Da Silva tests a female condom. (Olga Khazan)

The volunteer is with Gestos, a local nonprofit that works on STD prevention. One of its main projects is educating the women of Coelhos about female condoms, which the group hopes will help stem diseases like HIV and grant local women more autonomy in contraceptive decisions. Male condoms are widely available in the government-run clinics here, but the female variety haven’t been offered until recently.

Elieta, who works as a housekeeper, first learned about the condoms in July, when she saw a demo by Gestos at a nearby school. She tried them with her husband out of curiosity, and now the couple uses them sporadically, but not every time. Elieta likes the idea that she’s protecting herself from STDs. Low-income, married women in Brazil occasionally contract syphilis and HIV if their husbands visit prostitutes in secret.

But not all women in the community are as keen on female condoms as Elieta—or on any kind of birth control, for that matter.

Most of the residents of Coelhos, Elieta included, live in small cement houses with electricity, running water, and even flat-screen TVs. Most aren’t educated past high school, but their menial jobs do bring in a small amount of cash and with it, a semblance of middle-class modernity.

The yard outside Jeane's house (Olga Khazan)

But the outskirts of the neighborhood are another world. There, hundreds of families live in plywood shacks teetering on stilts moored in the muddy edges of the Capibaribe River. When it rains, the water runs right up to where the doorsteps would be, if they had doorsteps.

Outside one house, a tiny square yard is littered with damp palm leaves and other detritus. We walk under a clothesline strung with hand-washed underwear and into a dark hovel. On the first floor, a woman changes a baby on a large mattress on the bare floor.

Up a narrow wooden ladder on the second floor, we meet Jeane Gabriela Pires de Barros, a gorgeous 14-year-old who gave birth to a baby daughter, Jhenyffer, three months ago. Jeane says she lives here with her nine siblings. At night, they spread out among the family’s various bed rolls and mattresses – because Jeane has a baby, she gets the twin bed, but she must share it with a sibling.

Olga Khazan

Jhenyffer’s father is 17. Jeane hasn’t registered her birth yet because her mother must be the one to submit the papers, but her mother was in prison for drug trafficking when Jhenyffer was born.

Jeane can’t wait to go back to school, but she can’t do so until Jhenyffer enters a daycare in a few months. Daycare here, like healthcare, is free, but the spots are limited.

Jeane’s situation is typical among Brazil’s poor: Teen pregnancy rates are highest among those with the fewest resources. Abortion is illegal, but the rich can often arrange furtive illegal procedures or order abortifacients online.

Earlier that day, we had met Maria Do Carmo, a 30-year-old who is pregnant with her sixth child. She had her first when she was 15. That time was an accident, she said, but she never considered abortion and didn’t use birth control consistently afterward.

A house jammed with children isn’t necessarily a burden here, though. A baby born into even the most desperate situation is still greeted with squeals of delight. Throughout the visit, we had to pause whenever one of the local volunteers spotted a new mom sitting on the curb with her newborn so she could rush over to bounce it and coo.

Jeane and her baby. (Olga Khazan)

The rich have other ways of displaying their maturity, but among poor teenagers, having children can be a social-climbing strategy. When you share a cramped, leaky hut with an army of siblings and a frazzled adult, there can seem no better way to prove your worth than to become a mother.

“I have 13- and 14-year-old girls crying to me because their pregnancy test was negative, and they wanted to be pregnant,” said Janos Gyuricza, a primary care physician in Sao Paulo. “Getting pregnant is a way of becoming a woman. You finally have something of your own.”

Of the 262 women Gestos targeted with their female-condom promotion, about half continued to use them consistently, according to an internal report the organization later conducted.

The Gestos women say they try to sell the community’s teenagers on condoms, and the teens say they’ll use them. “But they’re flimsy,” one volunteer says. With few alternatives in sight, eventually many will attempt to affirm their social status the only way they know how.